(4) Memory (recent and remote). Ask the patient his social security number,
the city he is in, the building number, the state, and the names of two or three past
presidents of the United States.
(5) Knowledge (normal intellect). Ask the patient to name five large cities,
major rivers, etc. Another way to test this area is to ask the patient to tell you the
meaning of a fable, proverb, or metaphor. For example, explain:
(a) Too many cooks spoil the soup.
(b) A penny saved is a penny earned.
A stitch in time saves nine.
A person of average intelligence should be able to explain any of these phrases. A
person who can't explain any of these phrases may have organic brain syndrome, brain
b. Cerebellar Functions. These include tests for balance and coordination.
The cerebellum controls the skeletal muscles and coordinates voluntary muscular
(1) Finger-to-nose test. With his eyes open, instruct the patient to touch his
index finger to his nose.
(2) Rapid alternating movements test. Seat the patient. Instruct him to pat
his knees with his hands, palms down then palms up. Have him alternate palms down
and palms up rapidly. Watch the patient to notice if his movements are stiff, slow,
nonrhythmic, or jerky. The movements should be smooth and rhythmic as he does the
(3) Romberg test. Instruct the patient to stand with his feet together and his
arms at his side. Have the patient do this with his eyes open and then with his eyes
closed. (Stand close to the patient to keep him upright if he starts to sway.) Expect the
patient to sway slightly but not fall. This is a test of balance. If the patient really loses
his balance, he may have cerebellar ataxia or vestibular dysfunction.